REVIEW OF SYSTEMS--‐ Child Brief Cardiovascular

Name: _______________________________ □ Chest pain or discomfort A. Gestational age at delivery

DOB: __________________ □ Chest 8ghtness
**Please check only the symptoms your child □ Palpitatons (rapid
currently has** heartbeat)
□ Shortness of breath
General
□ abnormal weight gain GastrointesInal B. Labor and delivery -
□ abnormal weight loss □ Difficulty swallowing  length of labor,
□ Fa8gue/weakness □ Heartburn  fetal distress,
□ frequent fevers □ Nausea  type of delivery (vaginal, cesarean section),
□ Trouble sleeping □ Frequent vomi8ng  use of forceps,
□ Cons8pa8on  anesthesia,
Skin □ Diarrhea  breech delivery
□ Rash □ Blood in stool
□ Lumps C. Neonatal period
□ Itching Urinary
 Apgar scores,
□ excessively dry skin □ frequent urination
 breathing problems, use of oxygen,
□ Sun sensitivity □ Urgency to urinate
□ Hair and nail changes □ Burning/painful urination  need for intensive care,
□ Lower back pain  hyperbilirubinemia,
Head/Neck □ Dark or bloody urine  birth injuries,
□ Frequent headaches □ Decreased urine  feeding problems,
□ Head injury  length of stay,
□ Neck pain Musculoskeletal  birth weight
□ Neck s8ffness □ Painful joints
□ Swollen glands □ Frequent muscle aches V. Developmental History
□ Lumps □ Swollen joints A. Ages at which milestones were achieved and
□ Joint redness current developmental abilities –
Eyes □ Back pain  smiling
□ Eye redness □ Trauma  rolling
□ Eye pain □ Difficulties walking !  sitting alone
□ Eye discharge  crawling
□ Blurry or double vision Neurologic  walking
□ Vision loss □ Dizziness  running, 1st word, toilet training, riding tricycle,
□ Wear glasses/contacts □ Fain8ng etc (see developmental charts)
□ Other: ______________ □ Seizures
□ Weakness B. School-
Ears □ Tingling/numbness  present grade,
□ Decreased hearing □ Tremor (shaky hands)
 specific problems
□ Frequent ear pain □ Tics
 interaction with peers
□ Ear drainage □ Balance difficulty
□ Gait abnormality
C. Behavior -
Nose □ Headache
□ Constant nasal □ Loss of strength  enuresis
conges8on  temper tantrums
□ Nasal discharge/drainage Psychiatric/Behavioral  thumb sucking
□ frequent nosebleeds □ Frequent temper  pica
□ Sinus pain tantrums  nightmares etc.
□ Decreased sense of smell □ Severe separation
!!Throat/Mouth anxiety VI. Feeding History
□ Bleeding gums □ Sleep difficul8es A. Breast or bottle fed
□ Dry mouth □ Behavioral problems B. types of formula
□ Constantly sore throat □ School problems C. frequency and amount,
□ Hoarse voice D. reasons for any changes in formula
□ Thrush IV. Pregnancy and Birth History
□ Non--‐healing sores  Maternal health during pregnancy: E. Solids –
 bleeding, when introduced
 trauma, problems created by specific types
Respiratory  hypertension,
□ frequent cough  fevers, infectious F. Fluoride use
□ coughing up phlegm  illnesses,
□ Shortness of breath  medications,
□ Wheezing
 drugs, alcohol, smoking, rupture of membranes
□ Pain with breathing

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 Outline of a Pediatric Physical Examination D. Discharge 3. Edema
4. Clubbing
I.General VI. Mouth and Throat E. Gait
A. Statement about striking and/or important features. A. Lips (colors, fissures) 1. In-toeing, out-toeing
 Nutritional status, B. Buccal mucosa (color, vesicles, moist or dry) 2. Bow legs, knock knee
 level of consciousness C. Tongue (color, papillae, position, tremors) a. “Physiologic” bowing is frequently seen under 2
 toxic or distressed D. Teeth and gums (number, condition) years of age and will spontaneously resolve
 cyanosis E. Palate (intact, arch) 3. Limp
 cooperation, F. Tonsils (size, color, exudates) F. Hips
 hydration G. Posterior pharyngeal wall (color, lymph hyperplasia, 1. Ortolani’s and Barlow’s signs
bulging)
 dysmorphology,
H. Gag reflex X. Neurologic - most accomplished through
 mental state
observation alone
V. Neck A. Cranial nerves
B. Obtain accurate weight, height and OFC
A. Thyroid B. Sensation
B. Trachea position C. Cerebellum
C. Masses (cysts, nodes) D. Muscle tone and strength
D. Presence or absence of nuchal rigidity E. Reflexes
1. DTR
III. Skin and Lymphatics
VI. Lungs/Thorax 2. Superficial (abdominal and cremasteric)
A. Birthmarks - nevi, hemangiomas, mongolian spots
A. Inspection 3. Neonatal primitive
etc
1. Pattern of breathing
a. Abdominal breathing is normal in infants XI. GU
B. Rashes, petechiae, desquamation, pigmentation,
b. Period breathing is normal in infants (pause < 15 A. External genitalia
jaundice, texture, turgor
seconds) B. Hernias and Hydrocoeles
2. Respiratory rate 1. Almost all hernias are indirect
C. Lymph node enlargement, location, mobility,
3. Use of accessory muscles: retraction location, 2. Can gently palpate; do not poke finger into the
consistency
degree/flaring inguinal canal
4. Chest wall configuration C. Cryptorchidism
D. Scars or injuries, especially in patterns suggestive
1. Distinguish from hyper-retractile testis
of abuse
B. Auscultation 2. Most will spontaneously descend by several months
1. Equality of breath sounds of life
2. Rales, wheezes, rhochi D. Tanner staging in adolescents - See Tanner
IV. Head
3. Upper airway noise Staging handouts
A. Size and shape
E. Rectal and pelvic exam not done routinely –
C. Percussion and palpation often not possible and special indications may exist
B. Fontanelle(s)
rarely helpful
1. Size
VII. Cardiovascular
2. Tension - calm and in the sitting up position
A. Auscultation
1. Rhythm
C. Sutures - overriding
2. Murmurs
D. Scalp and hair
3. Quality of heart sounds
B. Pulses
V. Eyes
1. Quality in upper and lower extremities
A. General
1. Strabismus
VIII. Abdomen
2. Slant of palpebral fissures
A. Inspection
3. Hypertelorism or telecanthus
1. Shape
a. Infants usually have protuberant abdomens
B. EOM
b. Becomes more scaphoid as child matures
2. Umbilicus (infection, hernias)
C. Pupils
3. Muscular integrity (diasthasis recti)
D. Conjunctiva, sclera, cornea
B. Auscultation
E. Plugging of nasolacrimal ducts
C. Palpation
F. Red reflex
1. Tenderness - avoid tender area until end of exam
G. Visual fields - gross exam
2. Liver, spleen, kidneys
a. May be palpable in normal newborn
VI. Ears
3. Rebound, guarding
A. Position of ears
a. Have child blow up belly to touch your hand
1. Observe from front and draw line from inner canthi
to occiput
IX. Musculoskeletal
A. Back
B. Tympanic membranes
1. Sacral dimple
C. Hearing - Gross assessment only usually
2. Kyphosis, lordosis or scoliosis
B. Joints (motion, stability, swelling, tenderness)
V. Nose
C. Muscles
A. Nasal septum
D. Extremities
B. Mucosa (color, polyps)
1. Deformity
C. Sinus tenderness
2. Symmetry
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